First of all lets start with the fact that I am male :) And yes I realise that this post is long, but bare with it.
This all started three years ago and made its presence felt as an area of tension, around the bottom of where you'd say the bladder is and forward towards the front end of the pelvis, but behind the pubic bone. To feel the tension I'd have to lie down on my back, it wasn't painful, but just felt as if something was being pulled tight. All of a sudden however whatever it was that was being pulled tight let go, something moved and it felt as if something inside of me had ripped and I was left in agonising pain.
The pain itself felt/feels much like what the people in the linked thread are describing. However for me the pain is persistent rather then intermittent.
I also have a feeling now that there is a lot of referred pain involved. At the time I also mentioned to my GP that it felt like there was this thin string that stretched from my navel down to the bottom of my pelvis and that it felt as if it was being pulled tight and that this is what was causing the pain. As a result of this he referred me to Gastro where I had an examination, then an ultra sound and finally a CT scan. All of these came up negative, but by the time all of this had taken place the pain itself had become significantly better and appeared to be on the mend so it was left at that.
Both my GP and myself both felt at the time (and still do feel) that the pain is probably caused by a physical injury of some sort as the pain is very positional. When bad, every position is uncomfortable, but others are unbearable, such as lying flat on my back (this feels like the previously ripped tissue is being pulled on again and causes severe discomfort). But when the pain is better, as if it's healing itself to a certain degree, some positions are completely painless, whereas if I try and lie down...However if I take my time in lying down (this takes hours) the pain itself is far less severe. Kind of like I go from sitting to lying but in small controlled steps, going further into a lying down position with each step and letting whatever it is that's being stretched get comfortable with each step. So whatever it is that's damage is capable of extending that far but just cannot do it in one go - kind of like how you can end up doing the splits painlessly after stretching, but without you'd do some serious damage.
As I said this appeared to get better and to a certain degree it felt like it had, progress was extremely slow (18months), but over time whatever it was that was damaged felt as if it was healing. At its best I could lie down in bed on my back without feeling any discomfort or tension, but what I thought I was feeling was perhaps not quite as it should have been. I was on 25mg of amitriptyline/day at the time and had been for most of the duration of the injury, so when I thought it was better it wasn't quite there (I know the amitrip helps with the pain quite significantly). Subsequently I picked up a bag of something heavy (25kg) and supported it on my lower abdomen. I have always had strong stomach muscles so supporting the weight itself wasn't a problem and in doing so I didn't really feel any great discomfort, but a day later and the pain started to return and did so in earnest. I have no doubt in my mind that the picking up of the heavy weight was what caused the symptoms to get worse as physical activity has always been the number 1 trigger for making things worsen. The stomach muscles themselves aren't the problem, only I am sure that when you pick something that heavy up and support it where I did that it puts a lot of strain on the pelvic support muscles and ligaments too.
If I get back to the referred pain part of this though I believe that the actual injury sustained is down at the bottom of the pelvis and that the painful 'string' pulling sensation from the groin to the navel is in fact completely referred pain. The problem is down below (and is indeed stressed when lying down), but due to some people sharing nerve pathways between the navel and the groin (the shooting sensation one can create from navel > penis when one 'tweaks' their belly button etc) the pain/damage in the groin makes itself felt within the navel region and this causes confusion. I know that the pain feels at its worse when lying down and trying to 'reach' up for something, so one naturally assumes that something is perhaps being pulled between the navel and the pelvis, but this could perhaps be misleading.
I can gently manipulate the area between my navel and the pubic region and it doesn't cause any gross discomfort. If something was indeed being pulled tight between this region you'd expect it to cause some significant increase in pain (because lets face it the pain can be extreme), but it does not. I can however manipulate the area just around the navel oh so very gently with just one finger and cause an increase in discomfort. I believe the navel side of things is completely referred pain and although very real in how uncomfortable it is, it is in fact extremely misleading when it comes to people complaining about a pain that feels like the title implies. Doctors don't know what to do with it because it makes no sense, there are no connective structures that run from the navel to the lower groin, there are however lots of things down near the pelvic floor and above it that can be the cause of pain and then there are lots of nerves.
In my case the pain is generally always there, and I believe it to be muscular/skeletal in nature. In the other peoples' cases it could very well be that they have in fact strained a muscle a little, caused some minor damage to something within the pelvis through daily activity or a workout and this is what they would normally feel, but because the referred pain is actually worse then the real pain it throws off on making any kind of diagnosis. Lying down or stretching up naturally puts extra strain on all areas of the body (including stimulating nerves) and normally this doesn't result in any pain because the body is flexible and well designed against the internal organs/structures moving about. But if something is damaged or mildly inflamed, going to a positional extreme could cause an increase in discomfort because something is being stressed.
Following on from the 25kg lift the pain got worse and then, very slowly, started to get better, however once again boom it gets worse. This seems almost cyclic with a very slow repair rate and it taking a very short time (although not instant) to get worse.
So far I have had another abdominal ultrasound and another CT scan. Once again nothing was really found and I did try and have an MRI scan, but that was a complete failure, 40 minutes flat on my back with heavy sensors pushing down on my lower abdomen? I didn't even last 5 minutes. I have also had a digital rectal exam where my prostate was found to be fine.
Currently the following important things to mention are.
- Very rapid initial onset, only a matter of seconds, where it felt as if something had ripped internally after a feeling of something being under tension.
Signs of infection? :
- None whatsoever, nothing found in both my urine or my semen and I've never had a fever with it either.
- Pain is very positional, lying flat on my back is the worse thing I can do.
- Usually a change in position will always result in a change in discomfort.
- If the change in position was small and it caused increased discomfort, most of the time the additional pain will subside given time.
- If lying on my back, changing the position that my legs are in can have a profound impact on the level of discomfort, and always for the better (unless I try to put them back down)
- If I am lying flat on my back propping myself up and raising my shoulders etc dramatically reduces the pain.
- If lying on my side, changing the position of my legs also does the same thing as lying on my back, although some positions are worse and some are better.
- I cannot really lie on my front (I can't lie on my back either though).
- I can walk without feeling any great increase in discomfort and can use my legs normally.
- I have to keep some of the pelvic floor muscles tight in order to reduce the level of discomfort. I can relax them without any trouble mind you, but it hurts if I do so. It's as if they are helping to support something and if I relax them the support reduces and this causes something to be pulled on and it therefore hurts more. These are not the same muscles that one contracts to perform Kagels, although doing Kagels is somewhat uncomfortable it is not these muscles that are causing the pain.
- Increased discomfort on become sexually aroused. Pain is not generally felt within the penis although it can radiate.
- It is very uncomfortable to ejaculate, with the pain peaking from sexual arousal during the rhythmic pulses where all the pelvic floor muscles contract and with each contraction usually being more uncomfortable.
- It feels like the muscles in the pelvic floor that I normally hold tight, want to relax automatically on sexual arousal and this also adds to the discomfort as the two don't seem to go well together.
- Urinating is not uncomfortable and the stream is always strong. Only right at the end of urinating when the bladder is almost empty is there a feeling of discomfort, as if something is pulled upon when the bladder completely empties.
- Right at the end of urinating when all the muscles contract to close off the stream there is a significant increase in discomfort, this passes as the body adjusts and is much like a change in position from a more comfortable one to something worse.
- If I have a reasonably full bladder and push on it to the side this causes increased discomfort that is felt at the bottom of the bladder. It's like the bladder is full and acts like a water balloon and if pressed on at one end, it bulges out at the other and this pushes or pulls on something and it hurts.
- Having a full bladder in and of itself isn't particularly painful unless the general level of discomfort is extremely high.
- Eating a large meal tends to increase the level of discomfort by increasing the pressure in the abdomen and hence pushes down with more force.
- A few hours after the majority of the meal has been absorbed and the increased pain goes away.
- No specific foods appear to make the pain worse.
- Defecating isn't painful unless I have to push really hard, which I don't, so I don't. I still have to keep whatever muscle it is tight during defection though and this makes it feel like I cannot 'relax' into the event, which is the same with urinating too.
Medication tried :
- Amitriptyline but for sleep rather then pain management. This is quite effective at helping control the pain, both through it's ability to raise the pain threshold, but also apparently due to its secondary action as a smooth muscle relaxant.
- Buscopan, even though it has no analgesic properties of its own can have a profound impact on the level of discomfort (sometimes increasing it sometimes decreasing it).
- Co-codamol (codeine + paracetamol @ 30/500mg per tablet) does very little to control the pain.
- Tramadol, again does very little to control the pain.
This is all a bit confusing from my point of view and from the doctors point of view. I have not yet seen a physiotherapist, but I have been referred to pain management and physio is a part of that so I think it would be worthwhile seeing one.
I don't suppose anyone here has any idea what this could be, or whether or not it sounds like a certain ligament or muscle has been damaged? I would really like to have an MRI scan of the area but that is somewhat impossible given the circumstances. I am open to it being neurological in nature but if it was I wouldn't expect it to be so susceptible to certain physical activities causing it to get significantly worse and then seemingly go on the mend. The trouble, I feel, is that whatever it is that's damaged is trying to repair itself. But, because it is used on a daily basis and heavily stressed on a daily basis (trying to sleep) it doesn't quite get the chance it needs to sort itself out.
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